Eydawn

Hey, when you get into this stuff as a kid... you fall for the "cool" aspects. I'll 'fess up, I've been there. Fortunately, I've grown up a bit. Sum total of my whackerism... Carried gloves in my wallet for the first 2 years of college Told RA's I'd love to help with the vomiting drunks at 3am Put star of life stickers on my binders and a star of life on my dorm door Wore my venturing first responder uniform to my NREMT practical exams (to be honest, I did it for the psychological comfort zone... I was used to providing medical care in that outfit, just a navy blue T shirt with my crew's insignia and blue BDU's, and it put me in the right frame of mind, plus my notebook and all were exactly where I was used to having them on medical calls...) Learned which crew was on duty by the way they operated the siren (in my defense, my dorm in MI was literally 3 blocks from an ambulance post, so I heard them ALL the time...) Hmm... I own a kit, but it's BLS only, and it gets used at scouting events quite frequently, so I don't think that counts. No, it doesn't live in my car. No lights or sirens... my fiancee has a base station in his land cruiser, but again, that was primarily used at the summer camp we worked at... Just so happens the guy we bought it from programmed it for us for a lot of local FD and sheriff channels, so we get to listen to a lot of what goes on around us. We don't self launch on calls though... because neither of us is with a department and that's really stupid. He's skipping the whacker stage- lucky guy learned from my mistakes, lol. He's 3 weeks into his basic class and really enjoying it so far. Wendy CO EMT-B

Disgraceful... what a schmuck. I hope he gets canned and loses his license for unprofessional conduct. That stuff makes me mad. You want to bang a broad in your car, do it on your own time, not when someone needs your assistance and you're on the clock. Wendy CO EMT-B

Haha! I just wanted to see what the heck the joke was... knew it wasn't gals w/ no clothes somehow, maybe because of the poster.... Pretty funny! Wendy CO EMT-B

Hm. Looks like I'm going to have to do some research. Government jobs restricting things... well, that's the government and that's always happened. Wouldn't the FAA fall under that category as well? I assumed the military/government would do that... you choose to work for them, you give up your rights... Private companies REQUIRING disclosure of health information and basing hire status on the medications being taken as a general class... something still doesn't sound right about that. Paxil and Lithium don't do the same thing and aren't even the same category of drug (as far as I know). One's a controlled substance, the other isn't.... so a policy stating NO antidepressants doesn't make any sense to me. Can you see what you can pull as far as official policies and studies as well? This sounds like an interesting one to ferret out the details on. Never fail to learn something new every day in this place... Wendy CO EMT-B

If there are places that bar employment based on a diagnosis of depression OR treatment of that illness then they are skating a very thin line. That's extremely illegal. Note, I never said duties shouldn't be restricted if a medication did alter you... but that applies to pain relievers as well, doesn't it? Like common Vicodin for example... some extremely sensitive individuals shouldn't drive or operate machinery. If so, their duties must be changed. You can't fire someone for taking a prescription their doctor has given them for a specific condition. That's discrimination. Do these companies not hire or fire based on painkiller usage? And let's not forget that every individual responds differently to a medication... dependent upon gender, age, weight, history etc. Not every kid on ritalin is a zombie, and not every person on an antidepressant is altered by the medication. By the way, an employer can't legally ask you about your medical history. It's called HIPAA, no? You can volunteer that info, but they can't legally require it of you. The only thing I can think of is an involuntary 72 hour psychiatric hold showing up on a background check, thereby falling into a company's criteria and disqualifying someone for a job. That is something that proves to the company that the individual is mentally unstable. If you're going to profess that everyone with depression is mentally unstable, or that everyone taking an antidepressant has their functional capacity changed in a negative fashion, then I'm going to challenge it. Again, I don't follow your train of logic (bear with me )... you're saying that it's ok to cope with a disease in EMS, particularly depression in this case, but if coping with that disease involves an antidepressant, the person is no longer fit to work in EMS? You're saying that only treating the disease via one method (let's say counseling) is preferable to utilizing something to balance brain chemistry if the person works in EMS? That's like saying that you can only treat an injured ACL with rehab and stretching, but once the person needs painkillers and surgery, they're no longer capable of performing any physical activity. Sure, it might limit them some, but think about how many medics you know who wear knee braces... yes, they've got a bit of a deficit, but they still manage to perform their job adequately. Perhaps they need a leave of absence to regain full functionality.... but it doesn't mean they're never going to be fit to perform physical activity. What I am saying is that depression, like any other illness, has many different levels, and you can't assess how that illness is affecting someone just by looking at the label. If you're concerned about a depressed coworker's performance, you have to assess that performance and not make ASSUMPTIONS about anyone and everyone with depression, including those on medication. Yes, there are certain medications that should lead to restricted duty, or a different profession, IF THE DEFICIT is indicative of such. If you're going to assume that everyone on Prozac etc. is an incompetent medic, you're going to piss off a lot of people... and you aren't thinking. Just as a sense of perspective... I'm speaking as someone whose maternal side of the family has suffered depression, ranging from mild to severe depending on the relative. I also have bipolar and depressed coworkers and friends, and have had a great deal of experience in working with and speaking to individuals with depression. It's not as black and white as many people think. Wendy CO EMT-B

ICE is a very good tool if it's used. If you don't have time to use it, then oh well! The bored tech in the ER will get stuck with it, or registration will end up with it. Who says the relatives need to know the second something happens? It's especially useful if they're going to have to take the patient into surgery... helps the hospital get family involved in the decision, in my opinion. It's very good for laymen. They know about it, and often have more time to use it than the medics do, because while they're waiting for the medics to get to the scene there usually isn't a whole lot for them to do... I personally have my emergency contact people both in my phone and on my medical info card that lives in my wallet. My shiny steel bracelet says my name, what I'm allergic to, that I have asthma, and to see my wallet card. *shrugs* There is more than one way to identify a patient... or skin a cat! Wendy CO EMT-B

I know plenty of individuals working in the healthcare field that have been on or are currently on antidepressants. Yes, some of the side effects can be tricky, but can be adequately managed in a fashion that does not alter one's judgment (especially if the individual prescribing it is careful to achieve the maximum possible benefit at the lowest dose). Might take a few tweakings to get there, however. I believe that those in fire_911medic's workplace are very misinformed about antidepressants and how they work. They won't "prevent" burnout nor create "happy" medics. Antidepressants are a tool to be used in serious cases of depression that alter an individual's ability to function and think clearly. One of the hallmark signs of depression is that characteristic "fog", the inability to make decisions or evaluate the situation that one is in. Trust me, I'd rather have a medic who's actively confronting depression and cognizant of the fact that they *have* it (whether they're taking medication or not), than a medic who doesn't realize that their symptoms may be depression and may be affecting their ability to function. Being aware of it is half the battle. I would beg to differ that it is better to have unmedicated *diagnosable* depression in the EMS field for fear of side effects from the medication. If the medication is used wisely, in conjunction with constructive therapy sessions, it can help the person cope and make their thinking much clearer. If the medication is misused, (aka aerial Prozac spray) then you have higher potential for side effects and altered thinking where it didn't exist before. Also, I think people need to realize that there's a difference between your attention seeker "depressed" folks who eat prozac like M and M's, and those who suffer from serious clinical depression. Depression is an illness, just like any of the other things we treat on a daily basis. Mental illnesses are unique in that they have an organic component (altered brain chemistry or structure), and also a cognitive component (thinking patterns, life situations leading to the development of illnesses like depression). To say that no medic with depression should be allowed to operate in EMS is discrimination. If they are unable to perform their job, then they shouldn't be allowed in the field. You can't say that just because I have asthma and weak joints that I should never be allowed in the field; as long as I'm able to cope with my problems and perform at the same level as anyone else, no one has the right to tell me where I should or should not be working. That goes for any kind of illness or disability, whether it be physical or mental. If you're rampantly suicidal and/or can't make decisions, then yes, get off my ambulance and take some time off work. If you're coping with your depression and can function just as well as me or the next guy, why should it be anyone's business if you have depression or not? Wendy CO EMT-B

Hello, HIPAA, number one. Number two, what the heck is an EVMT? Wendy CO EMT-B

With our patient, I'd call him a stay and play with ALS so close by and do supportive care, reassurance, re-monitor vitals, etc. It's not going to really adversely affect your transport time, and while it looks like a simple concussion, something in the subject line makes me suspect something else like a CVA of some sort, or perhaps a medication or low blood sugar induced altered mental status. Since a paramedic can do a glucose stick and I can't in NJ, and the patient doesn't seem to be in critical condition, I think it's a valid call for stay and play while waiting for intercept. Ok, now what did I miss? Wendy CO EMT-B

In the state of Colorado (where I am) you can get your EKG cert. This means you can place a three lead on a patient and take a look at the strip, but not make any sort of differential diagnosis or treatment based on it. Basically you can get a rhythm strip for ALS going with this cert, and some of the really obvious stuff jumps out even at basics, like asystole or V fib, etc. Now, I don't *think* they've changed that since the last time I looked. I remember a few community colleges offering the EKG class last semester, but hey, they just issued new protocols for all of us so I may be wrong. Wendy CO EMT-B

Oh bummer! Sorry to hear it on the elbow! What'd you do to it the first time if you don't mind me asking? I know what you mean about pain making you irritable... I've got a possible hairline fracture to the 5th metatarsal in my right foot. Only thing is, Vicodin and Percocet make me hurl... lol! At least you can take summat for it. Hope you feel better soon Wendy CO EMT-B

By the way, please don't discount the forum or leave. We really are glad to have you here! The only way we learn is by discussion with one another, and no one is ever going to come to a consensus in here on the "right" way for EMS to operate, especially with all our regional variations. Wendy CO EMT-B

Ok. Let's take this nice and slow. The "you" that I referred to in my entire post was a generic "y'all in EMS". It has been a few weeks since I read the original post on this thread; in that post, I believe that you (specifically NYCntg in this instance) asked for advice on lightening your duty belt. I remember reading some of the suggestions, reading Dust's usual sarcasm with some decent advice sprinkled in it, and various tangents as usually happen in this forum. The response that I wrote earlier today was directed as a response to some of the other comments and posts that I read. I did not intend to demean anyone by implying that they were a moron. That last paragraph was my defense of those who prefer to carry more equipment, perhaps poorly worded. I was trying to counter some of the more vitriolic posts on that subject. I was basically trying to say, you want to carry stuff, your prerogative, hope you find a system that works for you. I prefer pockets. If I had realized that you were looking for technically innovative gear that minimizes weight, I would have addressed that. Missed it somewhere, mea culpa. I did not mean to cause offense by referring to anyone as a peon. If you take some time to get to know me, you'll realize that I use many different terms when referring to those lower down on the management food chain (MYSELF INCLUDED. I AM A PEON!). With that paragraph, I was trying to defend people who are *required* to carry a certain number and kind of items on their person, or face reprimand, which is what I gathered happens in NYC (from several posts in this thread). I do not carry a CPR mask on my person. Many do and feel more comfortable doing so. I was *trying* to make a list of common things that people hang off of their belts, and offering alternative stowing locations for those who don't want to wear large belts. I was trying to posit that it is possible to carry more equipment without becoming someone who inadvertently mirrors the behavior of someone who tries to convey that they are a capable medic by the content of their belt. I no longer live in Michigan. I attended school there for three years and the weather affected my asthma to my detriment. I am now back in my home state of Colorado. There are plenty of capable medics in Michigan, just as there are capable medics in NYC, Colorado, Arizona, Pennsylvania, you name it. There are also bass-ackwards medics *everywhere*. By the way, you will not see me attempt to claim that I am anything more than a competent EMT-Basic, striving for higher education, in any place on this forum. As a matter of fact I am fully aware that I am a novice when it comes to practicing medicine and that I have much to learn from people with more experience and knowledge than myself. The comments to not take things personally were addressed to anyone and everyone who's been rubbed the wrong way by some posts on here, especially those irritated by Dust (and trust me, I've been there haha~!). Please try to remember that all you have to express yourself with are words- the whole nonverbal level of communication is lost in this medium, ergo things that sound funny in someone's mind because they can verbally hear them being said are interpreted quite differently by someone reading the text alone. If something I said was misconstrued as a personal attack, or passive aggressive (and believe me I am anything but that, lol... if I'm pissed at you, trust me you will know) it was not intended in that manner. I do not automatically disrespect nor respect someone based on the agency they work for or where they operate. I judge people based on their descriptions of their care and how they interact with people in this forum. The protocols that I have seen displayed RE carrying items seem stupid to me, but then again I do not work in New York. *shrugs* Again, I didn't mean to disrespect nor attack anyone. If that was what you read, I am very sorry. I'll try to pull you some EMS tech sites if I can, since that's what you're after. And please, don't assume that I'm personally attacking you if something is sarcastic or seems like a jab. I reserve that kind of interaction for the PM box. And you'll notice, nowhere did I say your system was backwards or the bottom of the barrel, just as a response to your implication that I am behaving in a less than professional manner. PS SPENAC: Did you think he was referring to WendyT or did you see that he meant me, Eydawn? Wendy CO EMT-B

How far out are you from the nearest facility? What's ALS intercept time? Any change in significant findings? Wendy CO EMT-B

Well, I was hoping diabetic or traumatic head injury as a cause for the decreased LOC. Nevvamind on that one... high blood pressure meds? BP 182/86? That's a bit high. Any evidence of slurred speech or motor deficit? I would get the ALS medics on the way, since I can't figure out a simple cause for this and my new worry now is some sort of CVA. (stroke) Let's get a set of breath sounds on this guy. Can basics in NJ place 3 leads? If so, a simple EKG strip would be nice to see. Does he take any vitamins? How much blood pressure medication does he take, and does he remember how many he took this morning? Reassess vitals while you're waiting for ALS and heading to the rendezvous point... or just haul butt if they can't meet up with you in a justifiable amount of time. What kind of damage did the passenger side sustain? Did the car dive off any kind of hill and land with a nice jarring motion by any chance? So let me get this straight- the cars never impacted each other? Two ships passing in the night? So you have 2 scenes then. Just for clarification. Wendy CO EMT-B

Good luck! Another tip I've got is MAKE EYE CONTACT with the preceptor when you are doing or verbalizing something important. If you do this, you can make sure they hear what you are doing and are recognizing it. Verbalize everything you do, and go down the checklist for the practical in your mind. Wouldja believe I flunked the medical station my first go for NREMT-B because I initially said "stay and play" instead of "load and go"? Did everything right except assigning priority. Got to retake that one. It is easier the second time, though, because you've already done the station once and you have a better feel for how it works. I remember the first time, everyone was so darn nervous about the whole thing, it contributed to the environment as a whole. This time, hopefully you won't have that nebulous stress floating around you! Good luck, let us know how it goes! Wendy CO EMT-B

Yes, departments will have inane requirements. Personally, I don't think the O2 key is that bad of one... they're light and fit in a side pocket quite easily. If you are REQUIRED to carry certain items on your person, then, well, you have to carry them and make the best of it. Doesn't mean they all have to go on your belt. If there are non-required items that you carry for reasons known best to yourself, maybe you don't need to display them? For example... you will scarcely find me without a knife whenever I am wearing pants. (No pockets in skirts, bummer!) Why? Because I've carried a knife for a long time now. It's dead useful at a scout camp or any scouting event, and when I don't have it, I invariably need it. Do I have it in a holster on my belt? Nope. It's in my pocket, clipped to said pocket. Maybe you like a glove pouch. My personal favorite for that is a sandwich sized ziploc full of 2 pairs of gloves in my BDU pocket (because not everyone has non-latex gloves readily available, believe it or not). Waterproof, cheap, disposable if contaminated, and doesn't require display. CPR mask? Fits in the other BDU pocket, and hopefully I've got a BVM in the bag so I don't have to use the mask. Shears? Stick em sideways through your belt, right under the small of your back at that rear belt loop. They don't poke you when you sit down and lo and behold, they are there when you need them. Penlights and pens fit quite well in a shirt pocket or in a side pocket. The beating stick with optional lighting attachment (mag-light) should not have to be stuck to your person. That's about the only thing I could see absolutely needing to hang off a belt if it is in your required items. Dust, I think the problem doesn't necessarily lie with whackerism at the peon level here... sounds like an entrenched management whackodemic perhaps. Can't chide the peon for not being able to change management. And perhaps some providers who are very professional and don't have jury-rigged whackobelts, but who nonetheless feel more comfortable carrying multiple items because their personal experience has taught them such, should not take offense when Dust is chiding the less intelligent and less fortunate medics, or raving about their existence in general. You don't have to justify anything you carry, you know. No one is holding you accountable here or calling you a bad medic because you have 2 penlights and a shear holster. If it feels like a personal attack, take it with a grain of salt, or step back and try to critically re-evaulate your position if you have experienced some discomfiture at Dust's points. Maybe you do have too much crap! Maybe you don't. Only you can decide what to carry (within those stupid requirements in the case of NYC). Your pants, your body. If an extra tool is part of your comfort zone, who am I to call you a moron? Might as well yell at you for wearing lucky underwear or a saint medal or something. As long as it doesn't interfere with your performance nor reflect badly upon our profession, I really could care less. To each his own, as they say. Wendy CO EMT-B

Let's start with the basics. I want a rapid trauma full body exam, especially focusing on the head and neck. Do I see any evidence of head injury, either from vehicle condition (windshield star, restraint evidence) or the patient's physical exam? If so, I want C spine to become a priority soon... While I was looking for injuries, did I see any medical alert tags? Baseline vitals: respirations, pulse, BP, pupils, blood glucose, skin temp and condition. Let's assess his mental status and see what we can figure out. Now that we've got a basic game plan, can we have a description of the scene please? Was this a vehicle-vehicle incident? 2 people in the same car hitting a stationary object? What direction, what kind of impact, etc.? Wendy CO EMT-B

The scrub top idea with the BDU's or medic pants is not a bad idea. But, I think we need lettering across the back of the scrub as well as the front that says EMS, or your department, or something else for that matter. Plain scrub tops don't scream professional to me, any more than a T shirt does. And different colored tops are used to indicate different things in the prison population. Plain white top with darker pants, for example, indicates a suicide risk, at least for one prison close to where I live. Personally, I think polos are not a bad option. Here's why I think this. Polos are cost effective. You can get well constructed, climate comfortable polos for a department in a fairly cost effective manner. Collared shirts have always spoken to me as being more professional than non-collared shirts, and I think a tucked in scrub top would end up looking just like some V-neck shirt. Maybe I'm wrong. I will go try on a scrub top with EMS pants and get back to you, perhaps with pictures. What about purple, or *BRIGHT* green, think tennis ball or international safety placard green, or electric blue shirts? Green and blue come in variations, ya know. If you really want to stand out from your fellow responders and LEO's that much, then do it right. Pick a nice distinctive color and let's have that associated with EMS. I thought white was that color... but I agree that it is a pain to keep clean and that a bad shift will end up making me look like a slob to quite a few patients. Sorry, that doesn't help our professional image, and while theoreticals are always great, we have to operate in the real world. Also, if companies are forced to provide their employees with a million shirts so that they can change the instant they have some sort of soil, you're going to see a lot of employees in poorly made, cheap shirts. More so than we already see. Don't think that will help us here either. Well, that leaves us with one conclusion only... it's time to introduce the EMS muumuu... easy to fasten, fits multiple body configurations, and nice and comfy... Shall we argue about what color it should be? Wendy CO EMT-B

Nurse is wrong. Gotta agree there. If there is a high index of suspicion that the patient has a communicable disease such as those mentioned, like hepatitis, HIV, etc and you have been exposed to the patient's bodily fluids (especially due to something like a physical attack) they have to do testing. Have you contacted your supervisor? I would do so immediately. He or she is the one who can help get the ball rolling on this so hopefully you can find out quickly. The worst part with anything like that is not knowing. But definitely get your supervisor involved ASAP. While the nurse can brush you off, she can't brush your company off as represented by the supervisor (at least, not as easily). Wendy CO EMT-B

YOU ARE 5% WHACKER!!! NOT AN OUNCE OF WHACKER IN YOU. A LITTLE WHACKING IS FUN, TRY IT SOMETIME!!! BUY A BLUE LIGHT, OR PUT AN EMT STICKER ON YOUR CAR. YOU NEED MORE WHACKING IN YOUR LIFE. Go figure. Guess it's coz I don't really own any scanners or tattoos... Wendy CO EMT-B

Man those cricket and rugby players are harsh! I liked the one about "how are your wife and my kids..." That was pretty amusing. Wendy CO EMT-B

Didn't say it was a good idea to try to raise a family on minimum wage. Remember, I did say that there had to be something worthwhile in a job for one to remain in it. If the job is satisfying, but there is no way to make ends meet financially, the job ceases to be worthwhile, if family is your priority. All depends on the person and their situation. As to the cause and effect... I think the problem lies in how our EMS system is structured as a whole. I don't think you will see startling pay increases if all of a sudden new paramedics or EMT's start entering the field with bachelor's degrees in Emergency Medical Science, because experience is also where part of the pay scale determination comes from. Unless employers, cities, etc. want to increase their EMS budgets, there is nowhere for the pay raises to come from. And pardon me if I'm wrong, but the average American taxpayer isn't going to vote for EMS budget increases just because the folks have degrees. On the private side, I don't think people will start paying their bills just because the fellow who took them to the ER has a BS in something. Don't get me wrong- I am *not* arguing against education. Not at all. I am arguing that education will not necessarily equal a pay raise or a raise in respect by the community at large. And I'm also reiterating the point that someone can have a million degrees in science, humanities, psychology, Emergency Medical Science, and still be a *terrible* care provider. Yes, the more background knowledge you have to work with the better. I reap the benefits of my solid biology knowledge and familiarity with the molecular/cellular level of how folks work. But I can guarantee you that someone who got a higher grade in my Cell bio class has retained less of it and doesn't understand it. I guess my beef with this is that the American educational system is geared to select for those who test well. Test taking is a skill unto itself, and doesn't display the actual knowledge of the person. It shows how well they can reproduce the material on a test. The proof is in the pudding, as they say... I don't care what your GPA was or how many degrees you've got, *show* me that you can do something with it. I have always refused to respect someone simply because they sat in classrooms for 2 or 4 years and managed to pass their classes. I've met too many morons with degrees, and that is why I do not automatically associate a degree with intelligence or functional capability. On the flip side, I don't automatically disrespect someone with a degree either. Wendy CO EMT-B

Events that last a month?! What are you staging at, the SCA Pennsick wars? My gosh! My questions about personnel management include how many responders do you have and what kind of mobility you've got. Also what kind of terrain it is. One way to do this is to divvy up the acreage into zones and do a rotating stage in each zone, say you have 5 zones and 7 teams, teams 1,2 in a dedicated "ER" staging area, team 3 in zone 1, team 4 in zone 2, team 5 in zone 3.... with 1-3 hour rotation times. Depends on what kind of stuff you're going to be encountering, and what your response time from your "ER" staging area is to any given location. That's the way my venturing crew does it at any given event where we have "roaming" teams. That's one way to make sure you don't have wanderers all over the place, or all the medics in the same area. Just thank God you don't have to make sure that your teams have a 2:1 gender ratio if they're a mixed team.... that gets funky. Sorry for the aside (gotta love Boy Scouts of America Youth Protection Rules). You want dedicated EMS because fights and medical often go down at the same time in two different areas. You don't want your medics tied up doing something logistical or dealing with security issues if you have a high volume of people in your event, because the likelihood of something medical happening increases with the more people you have in the area. And medical is a much quicker way to get sued. Not to mention that split duties lead to less confusion. You don't have to worry about whether you're restraining someone as EMS or as security, for example... that can be a grey area, especially if alcohol or something else is involved. Will your medics be on foot, bicycle, motorbike, gator, golf cart? What are we looking at here? What is this event? I must admit, my curiosity is tweaked. Make sure your medics have shade, and plenty of access to water and facilities. I know it sounds stupid to say it, but having been at an event where neither was forthcoming, I know what a disaster it can be. Especially if you're doing this event for a month. (Seriously a month?!) That brings up sleeping quarters as well... how will you divvy up night shifts and what do you plan for that? Are there events going on at night, or is nighttime sleepytime for everyone? That should be enough questions to start with. I know it's more than you asked for, but I hope it's helpful. Best, Wendy CO EMT-B

One could ask the same question of teachers. Why do you work for such low pay and minimal benefits in your field? Why, you could have gotten a doctorate and at least have prestige to satisfy some of that lack! You could engage in conversations with others educated in your field and produce groundbreaking or at least intriguing work! Go ahead, ask any elementary or high school teacher why they teach for low pay, terrible benefits, and crappy hours. The answer you get won't be that they do it for the money, or that they do it for the respect (listen to the coffee room scuttlebutt in any public school and see how parents and administration treat a lot of teachers). They do it because they like it and because they find a sense of purpose in their job. Now, I know what you're going to say... at least teachers are educated. They at least have to have a bachelor's degree. Yea? Well, it still didn't get them decent pay, and many of them still suck. Education isn't in the time you sat your butt in the classroom to get the parchment on your wall... it's in your own motivation to pursue learning. I know plenty of people who will be graduating from college who have retained little if any workable knowledge, except how to pass an exam. Perhaps EMS will be paid more if we start requiring associate's or bachelor's degrees for any level of prehospital care provider. But I wouldn't say it is a cause and effect situation at all. You work in the profession you love, or you live your life by waking up miserable at the thought of going to work, every day of your life. Find the profession you love, and do whatever it takes to enjoy your work. Why do you think so many people work multiple jobs to supplement income, especially those who work in EMS? Because they want to continue working EMS instead of becoming desk jockeys or something similar. So they sacrifice and work hard to stay in the field. If there isn't something that makes the job worthwhile, you quit. Obviously, that worthwhile is not money, either for EMS or teachers. Just my way of looking at this one... Wendy CO EMT-B